Alcohol Poisoning, in the Shadow of a COVID-19 Pandemic: A 5-Year Review of Methanol and Ethanol Toxicity in Mazandaran; North of Iran

Alcohol Poisoning, in the Shadow of a COVID-19 Pandemic: A 5-Year Review of Methanol and Ethanol Toxicity in Mazandaran; North of Iran | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Alcohol Poisoning, in the Shadow of a COVID-19 Pandemic: A 5-Year Review of Methanol and Ethanol Toxicity in Mazandaran; North of Iran Yahya Saleh Tabari, Mohsen Saleh Saleh Tabari, Kimia Khonakdar, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6881945/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Oct, 2025 Read the published version in BMC Emergency Medicine → Version 1 posted 17 You are reading this latest preprint version Abstract Background The onset of the COVID-19 pandemic coincided with the widespread dissemination of misinformation regarding the protective role of alcohol against the virus. This led to a surge in the consumption of illicit alcoholic beverages and a rise in fatal methanol poisonings. Given the high incidence of alcohol poisoning in Mazandaran Province and the lack of comprehensive epidemiological data, this study aimed to examine the trends, characteristics, and outcomes of alcohol poisoning during and after the pandemic. Methods This retrospective cross-sectional descriptive study included all patients diagnosed with alcohol poisoning who were admitted to hospitals affiliated with Mazandaran University of Medical Sciences from 2020 to 2025. Data on demographics, type of alcohol consumed, clinical symptoms, mode of hospital arrival, and outcomes were extracted from hospital and EMS information systems. Chi-square and Fisher’s exact tests were used for categorical variables, while independent t-tests were employed for continuous variables. Results Of the 958 patients, 82.6% were male. The incidence of alcohol poisoning significantly decreased during the post-pandemic period (p = 0.003). Most cases occurred among young adults. Methanol ingestion was associated with a markedly higher mortality rate (29.4% vs. 8.6% for ethanol) and greater incidence of visual impairment. The dialysis rate was 10% in both groups. Logistic regression analysis identified methanol use, non-EMS transport, and lack of pre-hospital treatment as predictors of higher mortality. Interestingly, male gender was associated with better survival outcomes (p = 0.046). Conclusion These findings highlight the urgent need for early warning systems, targeted education for high-risk groups, and broader public awareness regarding the dangers of counterfeit alcohol during biological crises. Epidemiology alcohol poisoning methanol ethanol COVID-19 pandemic Figures Figure 1 Introduction At the onset of the COVID-19 outbreak in Iran, there was a sharp increase in public demand for personal protective equipment and ethanol-based sanitizing solutions, particularly those containing 70% ethanol. This unprecedented uptick resulted in extensive shortages. Concurrently, the spread of misleading and unverified information, particularly via social media and online platforms, promoted the false belief that ingesting or gargling alcoholic beverages could offer protection against COVID-19. As a result, alcohol consumption rose among segments of the population unaware of the associated health risks ( 1 ). In Iran, as in most Islamic nations, alcohol is forbidden by religious law, making its production, distribution, and consumption illegal. Although alcohol is banned, it is still accessible via black-market channels, including smuggling and homemade production, frequently in unregulated and hazardous conditions ( 2 ). On January 25, 2020 (one week after the official confirmation of the first COVID-19 cases in Iran), several patients were hospitalized in Tehran with acute methanol poisoning. These individuals reported consuming alcohol in an attempt to prevent SARS-CoV-2 infection, following claims circulating on social media. Within four weeks, the country experienced a nationwide methanol poisoning outbreak ( 2 ). By March 28, 2020, nearly 2,200 cases of methanol toxicity linked to the ingestion of illicit alcoholic beverages had been reported across Iran. Of these, 824 individuals (37.5%) required admission to intensive care units (ICUs), and 296 deaths were recorded, yielding a case fatality rate of 13.5%. More than 90% of the affected individuals were male, primarily aged 20 to 30 years (range: 5–72 years). Poisoning cases were documented in 18 of the country’s 31 provinces (58%), indicating a widespread distribution of counterfeit alcoholic products, according to the Iranian Ministry of Health, hospital officials, and the national forensic organization ( 1 ). It’s important to note that in Iran, the alcohol content in illegally manufactured alcoholic beverages is. It is often reported to be around 40% by volume (v/v), which is even higher than the concentration found in many of the strongest commercially available alcoholic drinks in Western countries ( 3 ). While methanol-containing products are relatively accessible, it is primarily unregulated, illicitly produced alcohol that leads to methanol poisoning ( 4 ). Methanol is associated with high mortality and a range of severe complications, including visual disturbances (particularly blindness), metabolic acidosis, cardiac arrhythmias, and extensive neurological damage. Its toxicity continues to be substantial even after hospital discharge ( 5 – 8 ). Poisoning typically results from direct ingestion, sometimes with as little as 15 milliliters, and rarely from inhalation or dermal absorption, which pose minimal risk. However, once metabolized, methanol becomes highly toxic, particularly to the central nervous system and the gastrointestinal tract ( 5 , 6 , 9 , 10 ). It is rapidly absorbed from the gastrointestinal tract—within less than 10 minutes—and reaches peak plasma concentration within 30 to 60 minutes ( 4 ). Following the onset of the COVID-19 pandemic, the dissemination of misinformation regarding the supposed disinfectant properties of alcohol resulted in a considerable surge in methanol-related fatalities. On March 26, 2020, Iran’s Ministry of Health reported a total of 5,011 methanol poisoning cases, including 505 confirmed deaths. In contrast, pre-2019 reports indicated substantially lower mortality rates from methanol toxicity ( 11 ). The recent surge, perhaps the most critical methanol outbreak in the country, coincided directly with the COVID-19 pandemic ( 12 ). Given the high incidence of alcohol poisoning and methanol-related mortality in Mazandaran Province, and the lack of sufficient epidemiological data on the geographic distribution of these outcomes during and after the COVID-19 pandemic, this study was designed to investigate the epidemiology of methanol poisoning, its clinical manifestations and management strategies, and the contributing factors. Moreover, the study plans to give evidence-based recommendations for the prevention and mitigation of methanol poisoning during public health emergencies, in order to inform targeted policymaking in education, public awareness, and health planning, both at the provincial and national levels. Moreover, there is a lack of detailed data on the pattern of alcohol poisoning in Mazandaran Province across different types of alcohol. Given the apparent shift in disease patterns following the COVID-19 pandemic, it is essential to assess the incidence of various forms of alcohol poisoning both during and after the pandemic. Such epidemiological insights are crucial for informed health planning and policy development in anticipation of future biological crises. Methods Patient Population and Study Setting: : This descriptive, retrospective cross-sectional study included all patients diagnosed with alcohol poisoning who were admitted to hospitals affiliated with Mazandaran University of Medical Sciences between 2020 and 2025. A complete enumeration method was employed. Data were extracted from the official patient records registered in the university's centralized medical information system. Collected variables included demographic characteristics, type of alcohol poisoning (methanol, ethylene glycol, ethanol, etc.), clinical symptoms, time of hospital admission and discharge, patient outcome, mode of hospital arrival (e.g., self-referral, Emergency Medical Services [EMS 911], inter-facility transfer), vital signs and Glasgow Coma Scale (GCS) score at initial presentation, length of hospital stay, presence of comorbidities, and the interval between alcohol ingestion and hospital arrival. Inclusion and Exclusion Criteria: All patients admitted with a confirmed diagnosis of alcohol poisoning from 2020 to 2023 were included. Exclusion criteria included patients admitted outside the defined time frame or those whose clinical records were incomplete. Data Sources and Collection Methods This study utilized two primary sources of data: a. Prehospital Emergency Response Data: This dataset encompasses key information, including the emergency location, the patient's residence, the time elapsed from the initial call to ambulance dispatch, the arrival time of the EMS, the duration spent on scene, and the transport time to the hospital. These records were gathered through collaborative efforts with the Emergency Department of Mazandaran University of Medical Sciences and were retrieved from the national Asayyar platform. b. Hospital Data: This dataset includes patient characteristics such as age, sex, and final diagnoses according to ICD-10 codes. It also contains information on the length of hospital stay and triage admission times, which are categorized into three groups: 8:00 a.m. – 4:00 p.m., 4:00 p.m. – 12:00 a.m., and 12:00 a.m. – 8:00 a.m. The data details the time to make a definitive decision, admission timing to wards, and patient outcomes (e.g., death, recovery, or discharge by request). Additionally, the dataset records various parameters, including medical interventions (such as dialysis), comorbid conditions, the type of alcohol involved (methanol, ethanol, or ethylene glycol), hospital names, modes of arrival (self-referral, EMS, or private ambulance), initial vital signs (blood pressure, blood sugar, respiration rate, heart rate), and the level of consciousness upon arrival. Data were extracted from each hospital’s Health Information System (HIS). Data Collection Process Upon obtaining the necessary ethical approval and clearance from relevant institutional bodies, we proceeded to extract pertinent records from the Emergency Operations Center at Mazandaran University of Medical Sciences, utilizing the resources provided by its medical documentation unit. The prehospital data were exported in Excel format from the Asayyar EMS system, which comprehensively logs all Prehospital Care Reports (PCRs). For hospital data, we accessed electronic health records (EHRs), employing ICD-10 codes to accurately identify and analyze patient-level variables. This methodology ensured a thorough examination of the relevant data for our research objectives. For this study, alcohol poisoning referred specifically to confirmed cases of ethanol or methanol toxicity, identified by the following ICD-10 codes: Ethanol poisoning: T51.0, F10.12 Methanol poisoning: T51.1 Data Analysis According to Iran’s Ministry of Health, the COVID-19 outbreak was officially identified in February 2020. The pandemic phase was characterized as running from April 2020 to March 2022, while the post-pandemic period is defined from April 2022 to March 2025 . In preparation for this analysis, the data underwent a thorough cleaning and formatting process. Subsequent statistical analyses were carried out using SPSS version 21. Descriptive statistics were presented as mean ± standard deviation (SD) for continuous variables, while categorical variables were expressed in terms of frequencies and percentages. To explore associations between categorical variables, the Chi-square test or Fisher’s exact test was employed. Independent-samples t-tests facilitated the comparison of means between groups. To pinpoint predictors of mortality, multivariate logistic regression was conducted. Additionally, univariate logistic models were utilized to examine the relationship between patient outcomes and several variables, including age, gender, and type of alcohol consumption. A significance level of P < 0.05 was designated as the threshold for statistical relevance. Ethical Considerations The Ethics Committee of Mazandaran University of Medical Sciences has approved this study. (Code: IR.MAZUMS.REC.1403.502). All procedures followed ethical guidelines. Data were anonymized, and personal identifiers were excluded from the analysis. Results Number of Patients and Temporal Distribution: A total of 958 patients with alcohol poisoning were admitted to hospitals affiliated with Mazandaran University of Medical Sciences between April 2020 and March 2025. The pandemic period (April 2020–March 2022) included 589 cases (53% of EMS-related dispatches), while 369 cases (24%) occurred post-pandemic. During the pandemic, a total of 110,814 emergency dispatches were recorded, compared to 152,700 in the post-pandemic phase. Of these cases, 589 (53% of all EMS-related dispatches) occurred during the pandemic period, while 369 (24%) were recorded during the post-pandemic phase. Notably, the total number of EMS calls resulting in dispatch during the pandemic was 110,814, compared to 152,700 in the post-pandemic period. Although overall emergency calls increased, the proportion of alcohol poisoning cases significantly decreased in the post-pandemic period ( P = 0.003 ) (Table 1 ). Demographic Characteristics: Among the 958 patients, 791 (82.5%) were male and 167 (17.5%) female, indicating a higher incidence among males. However, the difference between genders was not statistically significant ( P = 0.07 ) (Table 2 ). The mean age of patients was 32.36 years during the pandemic and 31.24 years during the post-pandemic phase. The highest incidence was observed in the 18–40 age group (71.2%), while the lowest frequency occurred among the elderly and very elderly (1.6%) (Table 1 ). Table 1 Distribution of alcohol poisoning and mortality cases by age groups during and after the COVID-19 pandemic Age groups Total Cases ER/Clinical Admissions * Dialysis Visual Impairment (Partial/Blind) ICU admission Deaths Discharged During COVID-19 pandemic Children (< 18 years) 58 20 9 0 4 6 19 Young Adults (18–40 y) 411 94 33 9 10 60 205 Middle-aged (41–65 y) 108 20 8 6 4 17 53 Early Elderly (66–74 y) 10 3 0 0 2 1 4 Elderly (75–84 y) 2 0 2 0 0 0 0 Very Elderly (≥ 85 y) 0 0 0 0 0 0 0 Total 589 137 52 15 20 84 281 Age Group After COVID-19 pandemic Children (< 18 years) 29 0 0 0 0 0 29 Young Adults (18–40 y) 271 5 38 2 0 14 212 Middle-aged (41–65 y) 66 7 10 1 0 13 35 Early Elderly (66–74 y) 3 0 0 2 0 0 1 Elderly (75–84 y) 0 0 0 0 0 0 0 Very Elderly (≥ 85 y) 0 0 0 0 0 0 0 Total 368 12 48 5 0 27 277 * ER/Clinical Admissions: Includes admissions to the Emergency Room or specialized hospital wards. Sex-Based Differences in Clinical Outcomes: Overall, female patients demonstrated a more favorable prognosis compared to male patients, and this difference was statistically significant across both the pandemic and post-pandemic periods ( P < 0.001 ) (Table 2 ). Table 2 Distribution of alcohol poisoning and mortality cases by gender during and after the COVID-19 pandemic Gender During COVID-19 pandemic ER/Clinical Admissions Dialysis Visual Impairment (Partial/Blind) ICU admission Deaths Discharged Male 118 47 15 15 76 217 Female 19 5 0 5 8 64 Gender After COVID-19 pandemic Male 11 43 5 0 26 218 Female 1 5 0 0 1 59 The disparity in clinical outcomes was particularly pronounced during the post-pandemic phase, as illustrated in ( Fig. 1 ). Table 3. Association between the type of alcohol consumed and patient outcomes during and after the COVID-19 pandemic Patient Prognosis Pandemic Post-pandemic total p-value Ethanol Methanol Ethanol Methanol < 0.001 ER/Clinical Admissions 129 8 10 2 149 Dialysis 45 7 41 7 100 Visual Impairment (Partial/Blind) 5 10 4 1 20 ICU admission 16 4 0 0 20 Deaths 60 24 11 16 111 Discharged 267 14 234 43 538 Total 522 67 300 69 958 Type of Alcohol Consumed and Clinical Outcomes: Across both periods, ethanol consumption was more prevalent than methanol. However, the proportion of methanol-related poisonings increased in the post-pandemic period, from 11.6–18.7% (Table 3 ). Outcome findings indicated that methanol poisoning was associated with a significantly higher mortality rate compared to ethanol (29.4% vs. 8.6%, respectively), with the difference being statistically significant (P < 0.001). Additionally, visual impairment occurred in 8.1% of methanol cases and 1.1% of ethanol cases. Dialysis rates were comparable between the two groups, affecting approximately 10% of patients in both (Table 3 ). Table 4 Association between the type of patient transport and patient outcomes during and after the COVID-19 pandemic Patient Prognosis Pandemic Post-pandemic Total EMS Others P-value EMS Others P-value ER/Clinical Admissions 53 84 < 0.024 10 2 < 0.001 149 Dialysis 25 27 26 22 100 Visual Impairment (Partial/Blind) 0 15 5 0 20 ICU admission 7 13 0 0 20 Deaths 33 51 14 13 111 Discharged 122 159 100 177 558 Total 222 367 141 228 958 Prognosis and Mode of Hospital Arrival: In both periods, the majority of patients (approximately 62%) arrived at the hospital through self-referral, while the remainder were transported by emergency medical services. Although the mode of arrival was not independently associated with prognosis ( P = 0.8 ), a combined analysis revealed statistically significant differences in clinical outcomes across the transport groups ( P < 0.05 ). Mortality and ICU admission rates were higher among patients who arrived via non-EMS methods (Table 4 ). Table 5 Association between alcohol consumption and travel-heavy cities during the pandemic and post-pandemic periods City period Pandemic Post-pandemic Nur 0 1 Chalous 12 91 Nowshahr 24 35 Kelardasht 0 19 Geographic Factors and Their Influence on Tourist Destinations: During the post-pandemic period, the incidence of alcohol poisoning significantly increased in popular tourist cities such as Chalous, Nowshahr, and Kelardasht. This geographic pattern was statistically significant ( P < 0.001 ) (Table 5 ). Discussion This study examined the epidemiological trends, clinical characteristics, and outcomes of alcohol poisoning over five years in Mazandaran Province. Overall, the findings indicated that although the number of emergency calls increased in the post-pandemic period, the proportion of alcohol poisoning cases declined during the same timeframe. These observations are consistent with global reports suggesting that the initial surge in alcohol-related poisonings in many countries coincided with the spread of misinformation regarding the alleged protective effects of alcohol against COVID-19 ( 1 , 13 ). For example, a study by Jacob et al. in the United Kingdom found that one in six individuals reported alcohol consumption during the pandemic, with a higher prevalence among adults( 14 ). In line with our findings, the majority of alcohol poisoning cases occurred in young adult males (aged 18–40 years). This observation is consistent with previous studies by Esmaeili et al. ( 15 ), Dehghan et al. ( 16 ), and Czeisler et al. ( 17 ). The lower prevalence of alcohol consumption among women may be attributed to multiple factors, including lower behavioral inclination toward alcohol use, as well as cultural, social, and religious restrictions that act as deterrents in many societies. In contrast, young men, due to socio-cultural pressures, economic hardship, and behavioral norms, are at greater risk of consuming illicit and unregulated alcoholic beverages. A notable finding in this study was the significantly better clinical outcomes among female patients. This difference may be due to variations in the quantity and type of alcohol consumed, earlier medical care-seeking behavior, or physiological differences between the sexes. In a study by Jangjou et al., the male-to-female ratio of alcohol poisoning was reported to exceed 4:1 during the pandemic. Although the overall mortality increased, the study found no statistically significant difference in mortality between genders—a finding that only partially aligns with our results. About the type of alcohol consumed, although ethanol remained the predominant agent, the proportion of methanol-related poisonings increased notably in the post-pandemic period. This shift in consumption pattern aligns with international reports from the COVID-19 era ( 8 – 10 ). In our study, methanol poisoning was associated with significantly worse prognoses, especially higher rates of mortality and visual impairment—findings that are in agreement with prior research highlighting the severe toxic effects of methanol ( 18 – 21 ). One of the main drivers behind the surge in methanol poisoning during the pandemic was the substitution of methanol for ethanol in alcoholic beverages and disinfectant products, primarily due to methanol's lower cost. As ethanol prices and demand soared, the use of methanol became more widespread. In mainly Muslim countries such as Iran, Malaysia, and Indonesia, where access to legally produced alcohol is restricted, the risk of exposure to counterfeit and unsafe alcoholic products is inherently higher ( 22 – 24 ). Additionally, widespread misinformation regarding the potential protective or therapeutic effects of consuming or gargling alcohol against COVID-19 led to a surge in alcohol use and subsequent methanol poisoning ( 25 ). A report by the U.S. Centers for Disease Control and Prevention (CDC) in July 2020 highlighted several cases of methanol poisoning linked to contaminated hand sanitizers in Mexico and Arizona. Among the Mexican cases, four individuals died, and one became permanently blind. In Arizona, six cases were reported, including one instance of permanent blindness ( 24 ). Limitations This study was based on retrospective data recorded in the hospital and pre-hospital emergency systems of Mazandaran University of Medical Sciences. Therefore, the findings are specific to a limited regional population and may not be generalizable to other provinces or national epidemiological patterns. Additionally, the analysis included only those patients who presented to healthcare facilities or were transported by emergency medical services. Cases of alcohol poisoning that result in death or complications before reaching the hospital might not be fully accounted for. This means that there could be an underestimation of the actual impact on mortality and morbidity associated with these incidents. Although some studies suggest that patients with severe methanol poisoning tend to seek care more promptly, the present study was unable to assess this relationship due to incomplete or inconsistent documentation regarding the interval between alcohol consumption and hospital presentation ( 25 ). Moreover, demographic, socioeconomic, and clinical background information, such as comorbidities or concurrent use of medications or substances, was not consistently recorded in many cases. This lack of comprehensive data may have influenced the interpretation and robustness of some findings. Conclusion This study demonstrated that the COVID-19 pandemic was associated with a significant increase in alcohol-related poisonings, particularly methanol toxicity, in Mazandaran Province. Although the number of cases declined in the post-pandemic period, Patients who consumed methanol experienced noticeably higher death rates and severe complications such as visual impairment and renal failure. Young males constituted the primary at-risk group, highlighting the need for targeted interventions. The observed increase in alcohol poisoning cases in high-traffic tourist areas underscores the role of geographic and social factors. These findings underscore the urgent need for early warning systems to detect mass poisoning outbreaks, especially during public health emergencies. Public education regarding the dangers of counterfeit alcohol, along with strengthened intersectoral collaboration among emergency services, hospitals, and research centers, is essential for optimal response. Prevention efforts should be prioritized for high-risk populations. This study provides a foundational evidence base to inform future policies aimed at reducing the burden of alcohol poisoning in times of crisis. Declarations Acknowledgments The authors would like to express their sincere appreciation to the staff of the Statistics and Crisis Operations Unit at Mazandaran University of Medical Sciences for their valuable cooperation in implementing this project. Author contributions Z.H. and Y.S. developed the original study proposal and wrote the draft manuscript. Z.S. and K.GH. performed data collection and processing. M.S. and H.T. conducted the statistical analysis.K.KH. Did the Final editing and translation of the article All authors critically revised the manuscript and approved the final version. Funding This research was not financially supported. Data availability Excel format of patient information is available if needed. Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Ethics Committee of Mazandaran University of Medical Sciences has approved this study. (Code: IR.MAZUMS.REC.1403.502). Participants gave their informed consent prior to inclusion in the study and Participants were assured that their identity would remain anonymous, and results would be published without disclosing any personal information . Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Soltaninejad K. Methanol mass poisoning outbreak, a consequence of COVID-19 pandemic and misleading messages on social media. Int J Occup Environ Med. 2020;11(3):148. Aghababaeian H, Araghi Ahvazi L, Ostadtaghizadeh A. The methanol poisoning outbreaks in Iran 2018. Alcohol Alcohol. 2019;54(2):128–30. Haghdoost A, Emami M, Esmaili M, Soberinia A, Nezhad Ghaderi M, Mehrolhassani M. 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Cite Share Download PDF Status: Published Journal Publication published 06 Oct, 2025 Read the published version in BMC Emergency Medicine → Version 1 posted Editorial decision: Revision requested 16 Jul, 2025 Reviews received at journal 15 Jul, 2025 Reviews received at journal 14 Jul, 2025 Reviewers agreed at journal 14 Jul, 2025 Reviewers agreed at journal 12 Jul, 2025 Reviewers agreed at journal 12 Jul, 2025 Reviews received at journal 12 Jul, 2025 Reviewers agreed at journal 10 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers invited by journal 08 Jul, 2025 Editor invited by journal 20 Jun, 2025 Editor assigned by journal 17 Jun, 2025 Submission checks completed at journal 17 Jun, 2025 First submitted to journal 12 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6881945","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":482905560,"identity":"d085a471-8c00-4430-81e7-5684423ac60c","order_by":0,"name":"Yahya Saleh Tabari","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Yahya","middleName":"Saleh","lastName":"Tabari","suffix":""},{"id":482905561,"identity":"d3e42883-d167-42c4-890d-81ffce44c770","order_by":1,"name":"Mohsen Saleh Saleh Tabari","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohsen","middleName":"Saleh Saleh","lastName":"Tabari","suffix":""},{"id":482905562,"identity":"197cdf41-3078-4bd1-bad1-cb9cd62e8de8","order_by":2,"name":"Kimia Khonakdar","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kimia","middleName":"","lastName":"Khonakdar","suffix":""},{"id":482905563,"identity":"b05b451a-4727-4dcc-9c42-11eb44392c95","order_by":3,"name":"Zeynab Sajjadi","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zeynab","middleName":"","lastName":"Sajjadi","suffix":""},{"id":482905564,"identity":"351c1ca1-a898-4616-8712-380cd89ee7fd","order_by":4,"name":"Kobra Gholami","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kobra","middleName":"","lastName":"Gholami","suffix":""},{"id":482905565,"identity":"15dc61ab-1004-4c4e-bf5a-435448006466","order_by":5,"name":"Hassan Talebi Ghadicolaei","email":"","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hassan","middleName":"Talebi","lastName":"Ghadicolaei","suffix":""},{"id":482905566,"identity":"bc15168a-5cc7-4520-a0c2-ee0c667f775e","order_by":6,"name":"Zoya Hadinejad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYLACxgYGxjYg9YCB4QBpWpgNSNPSwMDAJkGUFvn2HsMPjDvsZPvYzx6r5qm5I8fPwPzw0Q18FvScMZZgPJNs3MaTl3ab59gzY8kGNmPjHDxamCVyDCQY25gT2xhyzG7zsB1O3HCAh00anxY2iRzjH4xt9Ylt/G/Minn+EaGFRyLHDGjL4cQ2IIOZt40ILRI8x8osEtuOG7dJvDGWnNt32FiymYBf5NubN9/42FYtO78/x/DDm2+H5fjZmx8+xqeFgYHDgCEBymTiAZHMeJWDAPsDOJPxB0HVo2AUjIJRMBIBALcESd4/eJo4AAAAAElFTkSuQmCC","orcid":"","institution":"Mazandaran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Zoya","middleName":"","lastName":"Hadinejad","suffix":""}],"badges":[],"createdAt":"2025-06-12 15:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6881945/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6881945/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12873-025-01346-1","type":"published","date":"2025-10-06T15:57:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86658295,"identity":"d1f39187-b9fd-43a1-9f03-886041bde629","added_by":"auto","created_at":"2025-07-14 10:25:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":17873,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation between gender and prognosis of patients with alcohol poisoning\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6881945/v1/5a7e08154eea8ac82e684002.png"},{"id":93597466,"identity":"8b097f0e-0f4b-4abb-bd81-9504d878716d","added_by":"auto","created_at":"2025-10-15 14:08:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1072170,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6881945/v1/19052f9d-9f1a-47cc-a26a-d41989b36b2e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Alcohol Poisoning, in the Shadow of a COVID-19 Pandemic: A 5-Year Review of Methanol and Ethanol Toxicity in Mazandaran; North of Iran","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAt the onset of the COVID-19 outbreak in Iran, there was a sharp increase in public demand for personal protective equipment and ethanol-based sanitizing solutions, particularly those containing 70% ethanol. This unprecedented uptick resulted in extensive shortages. Concurrently, the spread of misleading and unverified information, particularly via social media and online platforms, promoted the false belief that ingesting or gargling alcoholic beverages could offer protection against COVID-19. As a result, alcohol consumption rose among segments of the population unaware of the associated health risks (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Iran, as in most Islamic nations, alcohol is forbidden by religious law, making its production, distribution, and consumption illegal. Although alcohol is banned, it is still accessible via black-market channels, including smuggling and homemade production, frequently in unregulated and hazardous conditions (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOn January 25, 2020 (one week after the official confirmation of the first COVID-19 cases in Iran), several patients were hospitalized in Tehran with acute methanol poisoning. These individuals reported consuming alcohol in an attempt to prevent SARS-CoV-2 infection, following claims circulating on social media. Within four weeks, the country experienced a nationwide methanol poisoning outbreak (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBy March 28, 2020, nearly 2,200 cases of methanol toxicity linked to the ingestion of illicit alcoholic beverages had been reported across Iran. Of these, 824 individuals (37.5%) required admission to intensive care units (ICUs), and 296 deaths were recorded, yielding a case fatality rate of 13.5%. More than 90% of the affected individuals were male, primarily aged 20 to 30 years (range: 5\u0026ndash;72 years). Poisoning cases were documented in 18 of the country\u0026rsquo;s 31 provinces (58%), indicating a widespread distribution of counterfeit alcoholic products, according to the Iranian Ministry of Health, hospital officials, and the national forensic organization (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt\u0026rsquo;s important to note that in Iran, the alcohol content in illegally manufactured alcoholic beverages is. It is often reported to be around 40% by volume (v/v), which is even higher than the concentration found in many of the strongest commercially available alcoholic drinks in Western countries (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). While methanol-containing products are relatively accessible, it is primarily unregulated, illicitly produced alcohol that leads to methanol poisoning (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMethanol is associated with high mortality and a range of severe complications, including visual disturbances (particularly blindness), metabolic acidosis, cardiac arrhythmias, and extensive neurological damage. Its toxicity continues to be substantial even after hospital discharge (\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Poisoning typically results from direct ingestion, sometimes with as little as 15 milliliters, and rarely from inhalation or dermal absorption, which pose minimal risk. However, once metabolized, methanol becomes highly toxic, particularly to the central nervous system and the gastrointestinal tract (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). It is rapidly absorbed from the gastrointestinal tract\u0026mdash;within less than 10 minutes\u0026mdash;and reaches peak plasma concentration within 30 to 60 minutes (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFollowing the onset of the COVID-19 pandemic, the dissemination of misinformation regarding the supposed disinfectant properties of alcohol resulted in a considerable surge in methanol-related fatalities. On March 26, 2020, Iran\u0026rsquo;s Ministry of Health reported a total of 5,011 methanol poisoning cases, including 505 confirmed deaths. In contrast, pre-2019 reports indicated substantially lower mortality rates from methanol toxicity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The recent surge, perhaps the most critical methanol outbreak in the country, coincided directly with the COVID-19 pandemic (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven the high incidence of alcohol poisoning and methanol-related mortality in Mazandaran Province, and the lack of sufficient epidemiological data on the geographic distribution of these outcomes during and after the COVID-19 pandemic, this study was designed to investigate the epidemiology of methanol poisoning, its clinical manifestations and management strategies, and the contributing factors. Moreover, the study plans to give evidence-based recommendations for the prevention and mitigation of methanol poisoning during public health emergencies, in order to inform targeted policymaking in education, public awareness, and health planning, both at the provincial and national levels.\u003c/p\u003e\u003cp\u003eMoreover, there is a lack of detailed data on the pattern of alcohol poisoning in Mazandaran Province across different types of alcohol. Given the apparent shift in disease patterns following the COVID-19 pandemic, it is essential to assess the incidence of various forms of alcohol poisoning both during and after the pandemic. Such epidemiological insights are crucial for informed health planning and policy development in anticipation of future biological crises.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatient Population and Study Setting: :\u003c/h2\u003e\u003cp\u003eThis descriptive, retrospective cross-sectional study included all patients diagnosed with alcohol poisoning who were admitted to hospitals affiliated with Mazandaran University of Medical Sciences between 2020 and 2025. A complete enumeration method was employed. Data were extracted from the official patient records registered in the university's centralized medical information system.\u003c/p\u003e\u003cp\u003eCollected variables included demographic characteristics, type of alcohol poisoning (methanol, ethylene glycol, ethanol, etc.), clinical symptoms, time of hospital admission and discharge, patient outcome, mode of hospital arrival (e.g., self-referral, Emergency Medical Services [EMS 911], inter-facility transfer), vital signs and Glasgow Coma Scale (GCS) score at initial presentation, length of hospital stay, presence of comorbidities, and the interval between alcohol ingestion and hospital arrival.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria:\u003c/h3\u003e\n\u003cp\u003eAll patients admitted with a confirmed diagnosis of alcohol poisoning from 2020 to 2023 were included. Exclusion criteria included patients admitted outside the defined time frame or those whose clinical records were incomplete.\u003c/p\u003e\n\u003ch3\u003eData Sources and Collection Methods\u003c/h3\u003e\n\u003cp\u003eThis study utilized two primary sources of data:\u003c/p\u003e\n\u003ch3\u003ea. Prehospital Emergency Response Data:\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis dataset encompasses key information, including the emergency location, the patient's residence, the time elapsed from the initial call to ambulance dispatch, the arrival time of the EMS, the duration spent on scene, and the transport time to the hospital. These records were gathered through collaborative efforts with the Emergency Department of Mazandaran University of Medical Sciences and were retrieved from the national Asayyar platform.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eb. Hospital Data:\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis dataset includes patient characteristics such as age, sex, and final diagnoses according to ICD-10 codes. It also contains information on the length of hospital stay and triage admission times, which are categorized into three groups: 8:00 a.m. \u0026ndash; 4:00 p.m., 4:00 p.m. \u0026ndash; 12:00 a.m., and 12:00 a.m. \u0026ndash; 8:00 a.m. The data details the time to make a definitive decision, admission timing to wards, and patient outcomes (e.g., death, recovery, or discharge by request).\u003c/p\u003e\u003cp\u003eAdditionally, the dataset records various parameters, including medical interventions (such as dialysis), comorbid conditions, the type of alcohol involved (methanol, ethanol, or ethylene glycol), hospital names, modes of arrival (self-referral, EMS, or private ambulance), initial vital signs (blood pressure, blood sugar, respiration rate, heart rate), and the level of consciousness upon arrival. Data were extracted from each hospital\u0026rsquo;s Health Information System (HIS).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Collection Process\u003c/h2\u003e\u003cp\u003eUpon obtaining the necessary ethical approval and clearance from relevant institutional bodies, we proceeded to extract pertinent records from the Emergency Operations Center at Mazandaran University of Medical Sciences, utilizing the resources provided by its medical documentation unit.\u003c/p\u003e\u003cp\u003eThe prehospital data were exported in Excel format from the Asayyar EMS system, which comprehensively logs all Prehospital Care Reports (PCRs). For hospital data, we accessed electronic health records (EHRs), employing ICD-10 codes to accurately identify and analyze patient-level variables. This methodology ensured a thorough examination of the relevant data for our research objectives.\u003c/p\u003e\u003cp\u003eFor this study, alcohol poisoning referred specifically to confirmed cases of ethanol or methanol toxicity, identified by the following ICD-10 codes:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEthanol poisoning: T51.0, F10.12\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMethanol poisoning: T51.1\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eAccording to Iran\u0026rsquo;s Ministry of Health, the COVID-19 outbreak was officially identified in February 2020. The pandemic phase was characterized as running from April 2020 to March 2022, while the post-pandemic period is defined from April 2022 to March 2025 .\u003c/p\u003e\u003cp\u003eIn preparation for this analysis, the data underwent a thorough cleaning and formatting process. Subsequent statistical analyses were carried out using SPSS version 21. Descriptive statistics were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for continuous variables, while categorical variables were expressed in terms of frequencies and percentages. To explore associations between categorical variables, the Chi-square test or Fisher\u0026rsquo;s exact test was employed. Independent-samples t-tests facilitated the comparison of means between groups.\u003c/p\u003e\u003cp\u003eTo pinpoint predictors of mortality, multivariate logistic regression was conducted. Additionally, univariate logistic models were utilized to examine the relationship between patient outcomes and several variables, including age, gender, and type of alcohol consumption. A significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was designated as the threshold for statistical relevance.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e The Ethics Committee of Mazandaran University of Medical Sciences has approved this study. (Code: IR.MAZUMS.REC.1403.502). All procedures followed ethical guidelines. Data were anonymized, and personal identifiers were excluded from the analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eNumber of Patients and Temporal Distribution:\u003c/h2\u003e\u003cp\u003eA total of 958 patients with alcohol poisoning were admitted to hospitals affiliated with Mazandaran University of Medical Sciences between April 2020 and March 2025. The pandemic period (April 2020\u0026ndash;March 2022) included 589 cases (53% of EMS-related dispatches), while 369 cases (24%) occurred post-pandemic.\u003c/p\u003e\u003cp\u003eDuring the pandemic, a total of 110,814 emergency dispatches were recorded, compared to 152,700 in the post-pandemic phase.\u003c/p\u003e\u003cp\u003eOf these cases, 589 (53% of all EMS-related dispatches) occurred during the pandemic period, while 369 (24%) were recorded during the post-pandemic phase. Notably, the total number of EMS calls resulting in dispatch during the pandemic was 110,814, compared to 152,700 in the post-pandemic period. Although overall emergency calls increased, the proportion of alcohol poisoning cases significantly decreased in the post-pandemic period (\u003cb\u003eP\u0026thinsp;=\u0026thinsp;0.003\u003c/b\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eDemographic Characteristics:\u003c/h2\u003e\u003cp\u003eAmong the 958 patients, 791 (82.5%) were male and 167 (17.5%) female, indicating a higher incidence among males. However, the difference between genders was not statistically significant (\u003cb\u003eP\u0026thinsp;=\u0026thinsp;0.07\u003c/b\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mean age of patients was 32.36 years during the pandemic and 31.24 years during the post-pandemic phase. The highest incidence was observed in the 18\u0026ndash;40 age group (71.2%), while the lowest frequency occurred among the elderly and very elderly (1.6%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of alcohol poisoning and mortality cases by age groups during and after the COVID-19 pandemic\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge groups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eER/Clinical Admissions\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDialysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVisual Impairment (Partial/Blind)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eICU admission\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDeaths\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eDischarged\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eDuring COVID-19 pandemic\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChildren (\u0026lt;\u0026thinsp;18 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYoung Adults (18\u0026ndash;40 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e411\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e205\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle-aged (41\u0026ndash;65 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly Elderly (66\u0026ndash;74 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElderly (75\u0026ndash;84 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery Elderly (\u0026ge;\u0026thinsp;85 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e589\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e281\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u003cp\u003eAfter COVID-19 pandemic\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChildren (\u0026lt;\u0026thinsp;18 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYoung Adults (18\u0026ndash;40 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e271\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e212\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle-aged (41\u0026ndash;65 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly Elderly (66\u0026ndash;74 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElderly (75\u0026ndash;84 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery Elderly (\u0026ge;\u0026thinsp;85 y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e277\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003e ER/Clinical Admissions: Includes admissions to the Emergency Room or specialized hospital wards.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eSex-Based Differences in Clinical Outcomes:\u003c/h2\u003e\u003cp\u003eOverall, female patients demonstrated a more favorable prognosis compared to male patients, and this difference was statistically significant across both the pandemic and post-pandemic periods (\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of alcohol poisoning and mortality cases by gender during and after the COVID-19 pandemic\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eDuring COVID-19 pandemic\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eER/Clinical Admissions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDialysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVisual Impairment (Partial/Blind)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eICU admission\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDeaths\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDischarged\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e217\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eAfter COVID-19 pandemic\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e218\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe disparity in clinical outcomes was particularly pronounced during the post-pandemic phase, as illustrated in ( Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 546px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Association between the type of alcohol consumed and patient outcomes during and after the COVID-19 pandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 90px;\"\u003e\n \u003cp\u003ePatient Prognosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 152px;\"\u003e\n \u003cp\u003ePost-pandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003etotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eEthanol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eMethanol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eEthanol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eMethanol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eER/Clinical Admissions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eDialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eVisual Impairment (Partial/Blind)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eICU admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eDeaths\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eDischarged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e538\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eType of Alcohol Consumed and Clinical Outcomes:\u003c/h2\u003e\u003cp\u003eAcross both periods, ethanol consumption was more prevalent than methanol. However, the proportion of methanol-related poisonings increased in the post-pandemic period, from 11.6\u0026ndash;18.7% (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Outcome findings indicated that methanol poisoning was associated with a significantly higher mortality rate compared to ethanol (29.4% vs. 8.6%, respectively), with the difference being statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eAdditionally, visual impairment occurred in 8.1% of methanol cases and 1.1% of ethanol cases. Dialysis rates were comparable between the two groups, affecting approximately 10% of patients in both (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between the type of patient transport and patient outcomes during and after the COVID-19 pandemic\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePatient Prognosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003ePandemic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003ePost-pandemic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eER/Clinical Admissions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual Impairment (Partial/Blind)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeaths\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDischarged\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e558\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e958\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePrognosis and Mode of Hospital Arrival:\u003c/h2\u003e\u003cp\u003eIn both periods, the majority of patients (approximately 62%) arrived at the hospital through self-referral, while the remainder were transported by emergency medical services. Although the mode of arrival was not independently associated with prognosis (\u003cb\u003eP\u0026thinsp;=\u0026thinsp;0.8\u003c/b\u003e), a combined analysis revealed statistically significant differences in clinical outcomes across the transport groups (\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e). Mortality and ICU admission rates were higher among patients who arrived via non-EMS methods (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between alcohol consumption and travel-heavy cities during the pandemic and post-pandemic periods\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity period\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePandemic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-pandemic\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNur\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChalous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNowshahr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKelardasht\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eGeographic Factors and Their Influence on Tourist Destinations:\u003c/h2\u003e\u003cp\u003eDuring the post-pandemic period, the incidence of alcohol poisoning significantly increased in popular tourist cities such as Chalous, Nowshahr, and Kelardasht. This geographic pattern was statistically significant (\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the epidemiological trends, clinical characteristics, and outcomes of alcohol poisoning over five years in Mazandaran Province. Overall, the findings indicated that although the number of emergency calls increased in the post-pandemic period, the proportion of alcohol poisoning cases declined during the same timeframe.\u003c/p\u003e\u003cp\u003eThese observations are consistent with global reports suggesting that the initial surge in alcohol-related poisonings in many countries coincided with the spread of misinformation regarding the alleged protective effects of alcohol against COVID-19 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). For example, a study by Jacob et al. in the United Kingdom found that one in six individuals reported alcohol consumption during the pandemic, with a higher prevalence among adults(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn line with our findings, the majority of alcohol poisoning cases occurred in young adult males (aged 18\u0026ndash;40 years). This observation is consistent with previous studies by Esmaeili et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), Dehghan et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and Czeisler et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The lower prevalence of alcohol consumption among women may be attributed to multiple factors, including lower behavioral inclination toward alcohol use, as well as cultural, social, and religious restrictions that act as deterrents in many societies. In contrast, young men, due to socio-cultural pressures, economic hardship, and behavioral norms, are at greater risk of consuming illicit and unregulated alcoholic beverages.\u003c/p\u003e\u003cp\u003eA notable finding in this study was the significantly better clinical outcomes among female patients. This difference may be due to variations in the quantity and type of alcohol consumed, earlier medical care-seeking behavior, or physiological differences between the sexes. In a study by Jangjou et al., the male-to-female ratio of alcohol poisoning was reported to exceed 4:1 during the pandemic. Although the overall mortality increased, the study found no statistically significant difference in mortality between genders\u0026mdash;a finding that only partially aligns with our results.\u003c/p\u003e\u003cp\u003eAbout the type of alcohol consumed, although ethanol remained the predominant agent, the proportion of methanol-related poisonings increased notably in the post-pandemic period. This shift in consumption pattern aligns with international reports from the COVID-19 era (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In our study, methanol poisoning was associated with significantly worse prognoses, especially higher rates of mortality and visual impairment\u0026mdash;findings that are in agreement with prior research highlighting the severe toxic effects of methanol (\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). One of the main drivers behind the surge in methanol poisoning during the pandemic was the substitution of methanol for ethanol in alcoholic beverages and disinfectant products, primarily due to methanol's lower cost. As ethanol prices and demand soared, the use of methanol became more widespread.\u003c/p\u003e\u003cp\u003eIn mainly Muslim countries such as Iran, Malaysia, and Indonesia, where access to legally produced alcohol is restricted, the risk of exposure to counterfeit and unsafe alcoholic products is inherently higher (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Additionally, widespread misinformation regarding the potential protective or therapeutic effects of consuming or gargling alcohol against COVID-19 led to a surge in alcohol use and subsequent methanol poisoning (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). A report by the U.S. Centers for Disease Control and Prevention (CDC) in July 2020 highlighted several cases of methanol poisoning linked to contaminated hand sanitizers in Mexico and Arizona. Among the Mexican cases, four individuals died, and one became permanently blind. In Arizona, six cases were reported, including one instance of permanent blindness (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study was based on retrospective data recorded in the hospital and pre-hospital emergency systems of Mazandaran University of Medical Sciences. Therefore, the findings are specific to a limited regional population and may not be generalizable to other provinces or national epidemiological patterns. Additionally, the analysis included only those patients who presented to healthcare facilities or were transported by emergency medical services. Cases of alcohol poisoning that result in death or complications before reaching the hospital might not be fully accounted for. This means that there could be an underestimation of the actual impact on mortality and morbidity associated with these incidents.\u003c/p\u003e\u003cp\u003eAlthough some studies suggest that patients with severe methanol poisoning tend to seek care more promptly, the present study was unable to assess this relationship due to incomplete or inconsistent documentation regarding the interval between alcohol consumption and hospital presentation (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMoreover, demographic, socioeconomic, and clinical background information, such as comorbidities or concurrent use of medications or substances, was not consistently recorded in many cases. This lack of comprehensive data may have influenced the interpretation and robustness of some findings.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that the COVID-19 pandemic was associated with a significant increase in alcohol-related poisonings, particularly methanol toxicity, in Mazandaran Province. Although the number of cases declined in the post-pandemic period, Patients who consumed methanol experienced noticeably higher death rates and severe complications such as visual impairment and renal failure. Young males constituted the primary at-risk group, highlighting the need for targeted interventions.\u003c/p\u003e\u003cp\u003eThe observed increase in alcohol poisoning cases in high-traffic tourist areas underscores the role of geographic and social factors. These findings underscore the urgent need for early warning systems to detect mass poisoning outbreaks, especially during public health emergencies. Public education regarding the dangers of counterfeit alcohol, along with strengthened intersectoral collaboration among emergency services, hospitals, and research centers, is essential for optimal response. Prevention efforts should be prioritized for high-risk populations. This study provides a foundational evidence base to inform future policies aimed at reducing the burden of alcohol poisoning in times of crisis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere appreciation to the staff of the Statistics and Crisis Operations Unit at Mazandaran University of Medical Sciences for their valuable cooperation in implementing this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZ.H. and Y.S. developed the original study proposal and wrote the draft manuscript. Z.S. and K.GH. performed data collection and processing. M.S. and H.T. conducted the statistical analysis.K.KH. Did the Final editing and translation of the article \u0026nbsp;All authors critically revised the manuscript and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was not financially supported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExcel format of patient information is available if needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles of the\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eEthics Committee of Mazandaran University of Medical Sciences has approved this study. (Code: IR.MAZUMS.REC.1403.502).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants gave their informed consent prior to inclusion in the study\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e and Participants were assured that their identity would remain anonymous, and results would be published without disclosing any personal information\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSoltaninejad K. Methanol mass poisoning outbreak, a consequence of COVID-19 pandemic and misleading messages on social media. Int J Occup Environ Med. 2020;11(3):148.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAghababaeian H, Araghi Ahvazi L, Ostadtaghizadeh A. The methanol poisoning outbreaks in Iran 2018. Alcohol Alcohol. 2019;54(2):128\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaghdoost A, Emami M, Esmaili M, Soberinia A, Nezhad Ghaderi M, Mehrolhassani M. Survey the status and causes of alcohol consumption: A case study of the epidemic alcohol poisoning in Rafsanjan in 2013. J Rafsanjan Univ Med Sci. 2015;13(10):991\u0026ndash;1006.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAskarian M, Khakpour M, Taghrir MH, Akbarialiabad H, Borazjani R. Investigating the epidemiology of methanol poisoning outbreaks: a scoping review protocol. JBI Evid synthesis. 2021;19(6):1388\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHovda KE, Hunderi OH, Tafjord AB, Dunlop O, Rudberg N, Jacobsen D. 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Int J Med Toxicol Forensic Med. 2021;11(3):33949.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWelle L, Medoro A, Warrick B. tainted hand sanitizer leads to outbreak of methanol toxicity during SARS-CoV-2 pandemic. Ann Emerg Med. 2021;77(1):131\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShadnia S, Rahimi M, Soltaninejad K, Nilli A. Role of clinical and paraclinical manifestations of methanol poisoning in outcome prediction. J Res Med sciences: official J Isfahan Univ Med Sci. 2013;18(10):865.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMousavi-Roknabadi RS, Arzhangzadeh M, Safaei-Firouzabadi H, Mousavi-Roknabadi RS, Sharifi M, Fathi N, et al. Methanol poisoning during COVID-19 pandemic; A systematic scoping review. Am J Emerg Med. 2022;52:69\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSefidbakht S, Lotfi M, Jalli R, Moghadami M, Sabetian G, Iranpour P. Methanol toxicity outbreak: when fear of COVID-19 goes viral. Emerg Med J. 2020;37(7):416.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAghababaeian H, Hamdanieh L, Ostadtaghizadeh A. Alcohol intake in an attempt to fight COVID-19: A medical myth in Iran. Alcohol. 2020;88:29\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJacob L, Smith L, Armstrong NC, Yakkundi A, Barnett Y, Butler L, et al. Alcohol use and mental health during COVID-19 lockdown: A cross-sectional study in a sample of UK adults. Drug Alcohol Depend. 2021;219:108488.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmin-Esmaeili M, Rahimi-Movaghar A, Sharifi V, Hajebi A, Mojtabai R, Radgoodarzi R, et al. Alcohol use disorders in Iran: Prevalence, symptoms, correlates, and comorbidity. Drug Alcohol Depend. 2017;176:48\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDehghan A, Sadeghi F, Afzali F. A Survey of Alcohol Poisoning and Disinfectants Cases in Patients Referred to Hospitals in Yazd Province during the Covid-19 Epidemic (First Wave of the Disease). J Shahid Sadoughi Univ Med Sci. 2022;29(11):4290\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCzeisler M\u0026Eacute;. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic\u0026mdash;United States, June 24\u0026ndash;30, 2020. MMWR Morbidity and mortality weekly report. 2020;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJangjou A, Ramezani M, Rahimi M, Mostafazadeh B, Evini PET, Shadnia S. The Trend of Poisoning During the COVID-19 and Post-COVID-19 Era in Tehran, Iran Between 2019 and 2023. Int J Med Toxicol Forensic Med. 2024;14(03).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHassanian-Moghaddam H, Zamani N, Kolahi A-A, McDonald R, Hovda KE. Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran\u0026mdash;a cross-sectional assessment. Crit Care. 2020;24:1\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYip L. Serious adverse health events, including death, associated with ingesting alcohol-based hand sanitizers containing methanol\u0026mdash;Arizona and New Mexico, May\u0026ndash;June 2020. MMWR Morbidity and mortality weekly report. 2020;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShokoohi M, Nasiri N, Sharifi H, Baral S, Stranges S. A syndemic of COVID-19 and methanol poisoning in Iran: Time for Iran to consider alcohol use as a public health challenge? Elsevier; 2020. pp. 25\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHolzman SD, Larsen J, Kaur R, Smelski G, Dudley S, Shirazi FM. Death by hand sanitizer: syndemic methanol poisoning in the age of COVID-19. Clin Toxicol. 2021;59(11):1009\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhalili Z, Nemati Vakilabad R, Gholipour F, Mehri S, Savadpoor M. Examining the Causes of Alcohol Consumption during the Covid-19 Pandemic: a Cross-sectional Study. J Health Care. 2023;25(1):19\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhoochani Khorasani A, Shirzad H. Differentiation of Coronavirus disease-19 (COVID-19) from methanol poisoning during the COVID-19 pandemic. J Police Med. 2020;9(4):181\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahdavi SA, Zamani N, McDonald R, Akhgari M, Kolahi A-A, Gheshlaghi F, et al. A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic. Sci Rep. 2022;12(1):9741.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Epidemiology, alcohol poisoning, methanol, ethanol, COVID-19, pandemic","lastPublishedDoi":"10.21203/rs.3.rs-6881945/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6881945/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe onset of the COVID-19 pandemic coincided with the widespread dissemination of misinformation regarding the protective role of alcohol against the virus. This led to a surge in the consumption of illicit alcoholic beverages and a rise in fatal methanol poisonings. Given the high incidence of alcohol poisoning in Mazandaran Province and the lack of comprehensive epidemiological data, this study aimed to examine the trends, characteristics, and outcomes of alcohol poisoning during and after the pandemic.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective cross-sectional descriptive study included all patients diagnosed with alcohol poisoning who were admitted to hospitals affiliated with Mazandaran University of Medical Sciences from 2020 to 2025. Data on demographics, type of alcohol consumed, clinical symptoms, mode of hospital arrival, and outcomes were extracted from hospital and EMS information systems. Chi-square and Fisher\u0026rsquo;s exact tests were used for categorical variables, while independent t-tests were employed for continuous variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf the 958 patients, 82.6% were male. The incidence of alcohol poisoning significantly decreased during the post-pandemic period (p\u0026thinsp;=\u0026thinsp;0.003). Most cases occurred among young adults. Methanol ingestion was associated with a markedly higher mortality rate (29.4% vs. 8.6% for ethanol) and greater incidence of visual impairment. The dialysis rate was 10% in both groups. Logistic regression analysis identified methanol use, non-EMS transport, and lack of pre-hospital treatment as predictors of higher mortality. Interestingly, male gender was associated with better survival outcomes (p\u0026thinsp;=\u0026thinsp;0.046).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThese findings highlight the urgent need for early warning systems, targeted education for high-risk groups, and broader public awareness regarding the dangers of counterfeit alcohol during biological crises.\u003c/p\u003e","manuscriptTitle":"Alcohol Poisoning, in the Shadow of a COVID-19 Pandemic: A 5-Year Review of Methanol and Ethanol Toxicity in Mazandaran; North of Iran","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 10:25:17","doi":"10.21203/rs.3.rs-6881945/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-16T05:09:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-16T01:57:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-14T11:37:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219788793556604224152658542271164135092","date":"2025-07-14T05:02:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297341046365700742091132782330941799462","date":"2025-07-12T16:32:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123630703185251531920283478205088517095","date":"2025-07-12T07:46:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-12T07:43:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138248951836935795494230895124949085286","date":"2025-07-10T07:36:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80114902902401795451918618074929496751","date":"2025-07-09T07:22:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"273006532399660520706710037067612102021","date":"2025-07-08T19:43:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156811383075064941444774519817951777007","date":"2025-07-08T19:23:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52676657178573500767915437126959947085","date":"2025-07-08T16:58:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-08T16:29:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-20T08:00:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-17T08:51:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-17T08:49:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2025-06-12T15:39:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ad20c080-0d52-4d5d-8dce-306d241b7ed3","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:05:53+00:00","versionOfRecord":{"articleIdentity":"rs-6881945","link":"https://doi.org/10.1186/s12873-025-01346-1","journal":{"identity":"bmc-emergency-medicine","isVorOnly":false,"title":"BMC Emergency Medicine"},"publishedOn":"2025-10-06 15:57:26","publishedOnDateReadable":"October 6th, 2025"},"versionCreatedAt":"2025-07-14 10:25:17","video":"","vorDoi":"10.1186/s12873-025-01346-1","vorDoiUrl":"https://doi.org/10.1186/s12873-025-01346-1","workflowStages":[]},"version":"v1","identity":"rs-6881945","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6881945","identity":"rs-6881945","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}